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You've asked and we've answered your questions about managing diabetes in the following categories:

Diet and nutrition

Weight management and physical activity

Cardiovascular disease risk and children

Many parents who are diabetic worry about their child’s risk for diabetes. It is true that having a family member with diabetes measurably increases the risk that a child may develop diabetes. Fortunately, with some knowledge and with help from your health care providers, there are things you can do to keep your children healthy.

Type 2 Diabetes Mellitus

Having a parent with type 2 diabetes increases a child’s risk for developing diabetes. This is related in part to genetics and in part to learned habits around exercise and eating. One way of thinking about it is that genes lay the groundwork, and the lifestyle allows for or protects against a diabetic predisposition. So, having a healthy lifestyle is extremely important.

The risk that your child will develop type 2 diabetes depends on the parent’s gender and how old they were when they were diagnosed; children of mothers diagnosed before the age of 50 years have significant risk, 1 in 7.

No medication has yet been shown to slow the progression to type 2 diabetes in children, although some medications may be useful in adults, and research is ongoing. Fortunately, lifestyle change can prevent diabetes in adults, and this is likely to be true in children as well.

Weight loss, regular physical exercise such as 30 minutes of brisk walking 5 times per week, healthy eating habits, and avoiding smoking decrease the risk of diabetes in adults. Research in children shows that having a healthy lifestyle can improve factors associated with diabetes, including weight, cholesterol and blood pressure. Some specific things you can do to improve your child’s health are:

• Limit screen time: Keeping screen time to 2 hours or less per day may reduce rates of obesity, an important risk factor for diabetes type 2
• Encourage a healthy diet: Serve lots of fruits and vegetables, unsalted nuts, low-fat (1%) or fat free dairy, high fiber and whole grain foods, fish twice per week, and limit intake of saturated fat and avoid trans fat. Choose healthy, monounsaturated and polyunsaturated fats and avoid highly processed foods that can be high in sodium. Limit sugar-saturated beverages and sweets.
• Aim for a healthy weight: helping your child work towards a healthy weight is an important way to reduce your child’s risk of diabetes. Children and adolescents should do 60 minutes or more of physical activity per day.
• Model good habits: Positive role modeling is important. Show your children that physical activity is important and can be fun by spending time playing actively. Keep in mind that if you don’t take care of yourself, it will be hard for your children to follow a healthy lifestyle.

Type 1 Diabetes Mellitus

For parents with the more rare type of diabetes mellitus, Type 1, the risk that your child will develop the disease depends in part on your gender and also the age you were diagnosed. Children of male type 1 diabetics have a 1 in 17 risk of contracting diabetes, while children of very early onset diabetics, those with two affected parents, and with multiple endocrine problems are at much greater risk (1 in 2-10). Breastfeeding may offer some protection from Type 1 diabetes. Some research has evaluated blood tests that may be available for siblings of children with type 1 diabetes; speak to your child’s doctor about this. So far, no medication has been shown to prevent type 1 diabetes in children, although research studies are ongoing.

Testing for Diabetes

You and your doctor can better understand your child’s individual risk for diabetes using blood testing. A fasting glucose test should be done in overweight children with 2 of the following risk factors: family history of Type 2 diabetes including gestational diabetes in the child’s mother, at risk racial/ethnic background, high risk medical conditions such as insulin resistance, PCOS or metabolic syndrome. Screening should be done at least every 2 years using either a fasting glucose or a glycosylated hemoglobin (hemoglobin A1C). A more specialized test (oral glucose tolerance test) can tell how the body responds to glucose and can help your provider evaluate your child more closely. Talk to your child’s doctor about these tests.

2.

I have heard that if I have type 2 diabetes, my risk for heart attack is the same as that of someone who has already had a heart attack. Is this true? Can you help me understand the relationship between type 2 diabetes and heart disease?

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Dr. Lori Mosca, an American Heart Association volunteer and director of preventive cardiology at New York-Presbyterian Hospital explains:

Type 2 diabetes is the type that often develops in adulthood, though more and more children and adolescents are also developing it. It's often associated with being overweight and leading a not-so-healthy lifestyle.

We've learned in our research that people with diabetes have almost the same risk of having a future heart attack as people who already have heart disease or other vascular disease. So diabetes is really one of the strongest risk factors we have.

Some of us feel so strongly about diabetes that we call it a risk equivalent, which means it's equivalent to having heart disease already. We are extremely aggressive with this risk factor, because we know that if you have diabetes, you are at substantially higher risk for future heart disease.

We also know that diabetes is associated with unhealthy levels of different types of blood cholesterol. So, people with diabetes tend to have an increased level of the bad cholesterol (LDL) and of triglycerides, and they tend to have reduced levels of the good cholesterol (HDL). This may be one of the explanations for why people with diabetes are at such high risk for heart attacks.

3.

My healthcare provider told me I have type 2 diabetes. He also told me that my risk for cardiovascular disease, such as heart attack or stroke, is very high. Why is the risk so much higher for me?

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Wahida Karmally, Dr.Ph., R.D., associate research scientist and director of nutrition of the Irving Center for Clinical Research in the Columbia University Medical Center in New York, explains:

Even when blood sugar levels are under control, diabetes increases the risk of heart disease and stroke. The risks are even greater if blood sugar is not well controlled. This occurs because diabetes causes damage to the blood vessels and arteries throughout the body including the ones that supply blood to your heart and brain. As this damage occurs, it becomes easier for plaque to form in the arteries. This buildup (atherosclerosis) is what can increase your blood pressure.

When high blood pressure exists with obesity, smoking, high blood cholesterol or diabetes, the risk of heart attack or stroke increases several times. It's very important to control your weight and blood cholesterol with a low-saturated-fat, low-cholesterol, plant-based diet and regular exercise. It's also important to lower high blood pressure and not to smoke.

Diabetes is a coronary heart disease risk equivalent. This means the risk for major coronary events is equal to that in established coronary heart disease. The risk for cardiovascular disease, such as heart attack and stroke, is higher because most people with diabetes have other health problems such as high blood pressure and blood cholesterol.

If you have diabetes, you can reduce your risk for cardiovascular disease and stroke by controlling your

1. Blood sugar — Aim for hemoglobin (HbA1c) below 7.
2. Blood pressure — Keep it below 130/80 mmHg.
3. Blood cholesterol — LDL-cholesterol target is less than 100 mg/dL; triglycerides less than 150 mg/dL; and HDL cholesterol greater than or equal to 40 mg/dL for men and greater than or equal to 50 mg/dL for women.

Managing your weight, eating a plant-based healthy diet, engaging in regular physical activity and taking medications (if prescribed by your healthcare provider) can also help you reach your treatment goals.